Rosuvastatin or Atorvastatin , Which is nice and protected ?

Rosuvastatin or Atorvastatin , Which is nice and protected ?

November 10, 2023 by dr s venkatesan

Statins belong to a gaggle of medication, stolen and reengineered from the blueprint of pure Chinese language pink yeast rice (Monocoline Ok) within the late Eighties. The remaining is the exceptional historical past within the pharma trade.

Statins straight interrupt the ldl cholesterol synthesis by blocking HMG-CoA inside the hepatocytes. It considerably lowers the LDL, fights human vascular atherosclerosis. It makes the plaque both regress, stop progress, make it tougher and within the course of make them much less weak . There are innumerable research that doc the proof. Statin has turn out to be a must-prescribe drug in anybody with clinically established CAD and even in hid CAD. Pointers can be found to prescribe statins numerous depth, relying on the danger profile.

Which statin ?

There was an extended checklist of statins. A lot of them have retired from the ring .At present, the combat is between Atorvastatin, a Rosuvastatin. Like Pepsi vs. Coke.

Notice the graphic ,A meteoric rise of 1 drug since 2005 . (Are you able to guess the rationale ?)

ATRORVA or ROSUVA Which one ought to I select ?

There may be little or no “one to 1” comparability examine between Rosuvastatin and Atorvastatin .The hole within the professionals and cons are slim. Following factors are noticed, with out a lot dispute.

1.Rosuvaststin is extra highly effective.

2.Plaque stabilisation impact isn’t totally different((Satrun, examine NEJM 2011 primarily based on IVUS)

3.New onset diabetic danger is extra probably with Rosuvastatin

4.Worsening of cataract can also be extra with Rosuvastatin

5.Atrovastatin has some further advantages in reducing triglycerides. (Bakker-Arkema RG, JAMA. 1996)

Nobody is dare sufficient to present sturdy verdict . Stunned to search out one this month. BMJ has come out with a doable reply. It’s referred to as LODESTAR trial (Ref 1)

Mechanism of recent onset diabetes with statins (REF 3)

It may be 7% with Rosuvastatin (much less with Atorvastatin). We predict, statins act primarily inside the hepatocytes the place ldl cholesterol synthesis takes place, however additionally they have a watch on the pancreatic β-cells as effectively. It down-regulates GLUT-4 in adipocytes, and ends in compromised insulin signalling. Moreover, statins’ affect on epigenetics can also contribute to statin-induced T2DM through differential expression of microRNAs.

Mechanism of cataract with statins (Ref 2)

The cells lining that line the lens are dynamic and require ldl cholesterol on a day-to-day foundation. Statins inhibit correct epithelial cell growth inside the crystalline lens, the place ldl cholesterol biosynthesis is important to keep up transparency and construction of the lens.

Ultimate message

So, is it Atorvastatin or Rosuvastatin? It’s left to you.

Thoughts you, “no statin in any respect” is the most suitable choice if circumstances and danger profile permits. Statins are by no means thought-about life-saving staple medication in our combat with CAD and atherosclerosis. We, together with our scientists may could make you’re feeling like that. Lipids will be managed inside fascinating means completely with food regimen and train in many of the inhabitants* .

(*Overlook about statins within the final 5000 years of recognized human existence, so many nice individuals have lived an extended and profitable life on this world, with out even realizing there’s an organ referred to as the center that’s liable for the circulatory system)

Reference

1.Lee YJ, Hong SJ, Kang WC, Hong BK, Lee JY, Lee JB, Cho HJ, Yoon J, Lee SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK; LODESTAR investigators. Rosuvastatin versus atorvastatin remedy in adults with coronary artery illness: secondary evaluation of the randomised LODESTAR trial. BMJ. 2023 Oct 18;383:e075837. doi: 10.1136/bmj-2023-075837. PMID: 37852649; PMCID: PMC10583134.

2.Leuschen J, et al Affiliation of statin use with cataracts: a propensity score-matched evaluation. JAMA Ophthalmol. 2013 Nov;131(11):1427-34.)

3.Carmena R, Betteridge DJ. Diabetogenic Motion of Statins: Mechanisms. Curr Atheroscler Rep. 2019 Apr 30;21(6):23. doi: 10.1007/s11883-019-0780-z. PMID: 31037345.